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There is a need to relieve the side effects caused by patients' care with the help of patient education. Internet-based patient education programs need more focus when developing new patient education methods.

Aim-To measure the local cerebral metabolic rate for glucose (LCMRGlc) in neonatal brains during maturation using positron emission tomography (PET) and 2-[18F]fluoro-2-deoxy-D-glucose (FDG).Methods-Twenty infants were studied using PET during the neonatal period. The postconceptional age ranged from 32-7 to 603 weeks. All infants had normal neurodevelopment and were normoglycaemic. The development of the infants was carefully evaluated (follow up 12-36 months) clinically, and by using a method based on Geseli Amatruda's developmental diagnosis. LCMRGlc was quantitated using PET derived from FDG kinetics and calculated in the whole brain and for regional brain structures. Results-LCMRGlc for various cortical brain regions and the basal ganglia was low at birth (from 4 to 16 pumol/100 g/minute). In infants 2 months of age and younger LCMRGlc was highest in the sensorimotor cortex, thalamus, and brain stem. By S months, LCMRGlc had increased in the frontal, parietal, temporal, occipital and cerebellar cortical regions. In general, the whole brain LCMRGlc correlated with postconceptional age (r=090; P<0001). The change in the glucose metabolic pattern observed in the neonatal brain reflects the functional maturation of these brain regions. Conclusion-These findings show that LCMRGlc in infants increases with maturation. Accordingly, when LCMRGlc is measured during infancy, the postconceptional age has to be taken into account when interpretating the results.(Arch Dis Child 1996; 74: F153-F157) Keywords: cerebral metabolic rate of glucose, positron emission tomography.

OBJECTIVE. Our goal was to test the hypothesis that the level of the delivery hospital affects 1-year mortality of very preterm infants in Finland.PATIENTS AND METHODS. This retrospective national medical birth-register study included 2291 very preterm infants (gestational age of Ͻ32 weeks at birth or birth weight of Յ1500 g) born in 14 level II (central) and 5 level III (university) hospitals in 2000 -2003. The main outcome measures were adjusted total mortality (including stillbirths) and mortality of live-born infants until the age of 1 year.RESULTS. Both the total 1-year mortality and the 1-year mortality of live-born infants were higher in level II hospitals compared with level III hospitals. Total mortality was higher in very preterm infants who were not born during office hours. In theory, delivery of all very preterm infants in level III instead of level II hospitals translates into an annual prevention of 69 of the 170 total deaths and prevention of 18 of the 45 deaths of live-born infants.CONCLUSIONS. Resources in neonatal intensive care should be increased, especially during non-office hours, to have an equally distributed service through the 24-hour day. More efficient regionalization of very preterm deliveries may improve 1-year survival of very preterm infants in Finland.

The physical growth of 519 small for gestational age infants (SGA), with a birth weight below the 10th percentile on our own growth curve, born in the region of University Central Hospital of Turku during the period June 1, 1981-May 31, 1982, was studied. The study population consists of 4,517 term, appropriate for gestational age (AGA) infants, 488 term SGA infants, 320 preterm AGA infants and 31 preterm SGA infants. The degree of intrauterine growth retardation (IUGR) seemed to have an effect on physical growth in term SGA infants. Those term SGA infants with a low Ponderal Index (PI) (type II) were taller and had a larger head circumference at the age of 24 months than term SGA infants with adequate PI (type I). Among the preterm SGA infants the degree of IUGR seemed to have no effect on later growth. Smoking is still one of the main risk factors associated with poor intrauterine growth. In this study we also found that smoking has an effect on later growth; the children of smoking mothers were smaller than those of non-smoking mothers in the AGA group. Among the SGA infants the infants of non-smoking mothers were bigger than those of smoking mothers. This difference could be explained by other factors associated with SGA. We found that in spite of the catch-up growth during the first months, 26% of the severely SGA infants (birth weight below the 2.5th percentile) still had a weight below the 2.5th percentile at the age of 24 months.

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Children with acute otitis media were excluded because they are routinely treated with antibiotics. Children with tonsillitis were excluded because a separate study was being carried out of tonsillitis. There were 70 girls and 84 boys. Seventy eight (51%) children were less than 2 years old, 42 (27%) between 2 and 6 years, and 34 (22%) over 6 years old. The mean age was 3 years 4 months with a range of 2 months to 14 years.The outpatients received a questionnaire for follow up of the symptoms and signs of the disease. Re-examination was performed in 83 of 97 outpatients seven days after the first visit, and the questionnaire was returned. The follow up was conducted by telephone in another 13 patients, and one patient returned the questionnaire by mail. The inpatients were treated in the hospital until afebrile and were not routinely re-evaluated.Blood was taken for routine haematologic tests (total white blood cell counts (WBC) and differential counts, erythrocyte sedimentation rate (ESR), and CRP). Nasopharyngeal mucus aspirates for rapid diagnosis of virus was taken from 135 children.

Healthcare is an information-intensive field, as information is needed to make strategic, tactical, and operational decisions. The purpose of this study was to identify the tactical decisions that middle management healthcare managers make, the information that is available, and the necessary information that is missing using the cardiac care process as an example. Data were collected through focused interviews of nurses and physicians who work in middle management in a secondary healthcare field. The interviews were coded and analyzed using the thematic content analysis method. We identified two main categories of tactical decisions: those concerning the process of care and those concerning the resources for the care. We termed the categories "process decisions" and "resource decisions." The availability of information varied. Much of the necessary information was created and processed manually. Our results show that the collection, mining, and systematic use of information are difficult because of the existence of many types of information systems and their varying abilities to produce and report information. Finally, much of the important information is missing. In conclusion, the information management process in healthcare settings needs to be improved, and a new generation of information system is needed to support tactical decision making in middle management.